Provider Demographics
NPI:1043073125
Name:AMON MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:AMON MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-738-9230
Mailing Address - Street 1:609 GOLD AVE SW STE 1H
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3119
Mailing Address - Country:US
Mailing Address - Phone:505-717-1903
Mailing Address - Fax:
Practice Address - Street 1:609 GOLD AVE SW STE 1H
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3119
Practice Address - Country:US
Practice Address - Phone:505-717-1903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies